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Kawano D, Matsumoto K, Narita M, Tanaka N, Naganuma T, Sasaki W, Mori H, Ikeda Y, Kato R. Four-Stage Rocket technique: A novel strategy for lead extractions using laser sheaths from the femoral vein. J Cardiovasc Electrophysiol 2024; 35:1701-1705. [PMID: 38845191 DOI: 10.1111/jce.16312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 08/03/2024]
Abstract
INTRODUCTION Transvenous lead extractions (TLEs) for cardiac implantable electronic device complications often encounter difficulties with strong adhesions to the myocardium or vessels. In this report, we introduce a novel "Four-Stage Rocket" technique for effective TLE in cases where conventional methods fail. METHODS AND RESULTS Two challenging cases where conventional TLE methods failed were treated using a combination of four devices: Needle's Eye Snare, Agilis NxT Steerable Introducer, GlideLight Laser sheath, and GORE® DrySeal Flex Introducer sheath, employed via the inferior vena cava. The "Four-Stage Rocket" technique successfully detached firmly adhered leads near the tricuspid valve annulus, where the traditional superior vena cava approach was inadequate. CONCLUSION The "Four-Stage Rocket" technique offers a potential alternative in complex TLE cases, aligning the laser direction with the adhesion detachment and reducing the tissue damage risk.
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Affiliation(s)
- Daisuke Kawano
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Kazuhisa Matsumoto
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Masataka Narita
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Naomichi Tanaka
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Tsukasa Naganuma
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Wataru Sasaki
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan
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2
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Knapp WP, O'Leary ET, Quinn B, Porras D, Mah DY. Safety and efficacy of combined dilation/stenting of venous abnormalities, including complete obstructions, during lead extractions in patients with congenital heart disease. J Cardiovasc Electrophysiol 2024; 35:694-700. [PMID: 38332493 DOI: 10.1111/jce.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/04/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Management of transvenous leads in patients with congenital heart disease (CHD) can be complicated by venous obstructions and residual shunts. We present our experience performing concurrent lead extraction and dilation/stenting of venous pathways, including patients with complete venous obstruction. METHODS All cases of concurrent lead extraction and recanalization of vena cavae/baffles between 2017 and 2021 at Boston Children's Hospital were retrospectively included and reviewed for safety and efficacy. RESULTS Eight patients, 4 female, median 38.5 years of age (range 16.7-49 years) and 81.6 kg weight (range 41.3-97.8 kg) at time of procedure were included. All patients had CHD, a majority (n = 7) having transposition of the great arteries palliated via atrial switch. All leads were removed in their entirety, with most patients having two leads extracted (n = 7). Median lead dwell time was 13.8 years (range 3.6-35.3 years). Three patients had complete obstructions, three required stenting of their innominate veins and three required recanalization of their femoral vessels. Median procedure time was 9.8 h (range 5.4-12.8 h). Complications included blood transfusion (n = 2), arrhythmia (n = 3), pleural effusion (n = 1), and pressure ulcer (n = 1). There were no cardiac perforations, venous tears, or deaths. CONCLUSION Lead extraction along with dilation and stenting of venous anomalies, though long in duration, proved effective with minimal complications. This combined procedure can safely and effectively resolve complete obstructions secondary to transvenous leads.
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Affiliation(s)
- William P Knapp
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Brian Quinn
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Diego Porras
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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3
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Kim BS, Gabriels JK, Saleh M, Epstein LM. A "hands-on" approach to femoral lead extraction: Indications, tools, and techniques. Heart Rhythm 2024; 21:213-223. [PMID: 37952865 DOI: 10.1016/j.hrthm.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Beom Soo Kim
- Department of Cardiology, Northwell Health and the Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.
| | - James K Gabriels
- Department of Cardiology, Northwell Health and the Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Moussa Saleh
- Department of Cardiology, Northwell Health and the Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Laurence M Epstein
- Department of Cardiology, Northwell Health and the Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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Dasgupta S, Mah DY. Lead Management in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:481-491. [PMID: 37865521 DOI: 10.1016/j.ccep.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Pediatric patients with congenital heart disease present unique challenges when it comes to cardiac implantable electronic devices. Pacing strategy is often determined by patient size/weight and operator experience. Anatomic considerations, including residual shunts, anatomic obstructions and barriers, and abnormalities in the native conduction system, will affect the type of CIED implanted. Given the young age of patients, it is important to have an "eye on the future" when making pacemaker/defibrillator decisions, as one can expect several generator changes, lead revisions, and potential lead extractions during their lifetime.
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Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, 231 East Chestnut Street, Louisville, KY 40202, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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5
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Akhtar Z, Kontogiannis C, Elbatran AI, Leung LWM, Starck CT, Zuberi Z, Sohal M, Gallagher MM. Transvenous lead extraction: Experience of the Tandem approach. Europace 2023; 25:euad331. [PMID: 37936325 PMCID: PMC10903175 DOI: 10.1093/europace/euad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
AIMS Transvenous lead extraction (TLE) is important in the management of cardiac implantable electronic devices but carries risk. It is most commonly completed from the superior access, often with 'bail-out' support via the femoral approach. Superior and inferior access may be used in tandem, which has been proposed as an advance in safety and efficacy. The aim of this study is to evaluate the safety and efficacy of the Tandem approach. METHOD The 'Tandem' procedure entailed grasping of the targeted lead in the right atrium to provide countertraction as a rotational dissecting sheath was advanced over the lead from the subclavian access. Consecutive 'Tandem' procedures performed by a single operator between December 2020 and March 2023 in a single large-volume TLE centre were included and compared with the conventional superior approach (control) using 1:1 propensity score matching; patients were statistically matched for demographics. RESULTS The Tandem in comparison with the conventional approach extracted leads of much greater dwell time (148.9 ± 79 vs. 108.6 ± 77 months, P < 0.01) in a shorter procedure duration (96 ± 36 vs. 127 ± 67 min, P < 0.01) but requiring more fluoroscopy (16.4 ± 10.9 vs. 10.8 ± 14.9 min, P < 0.01). The Tandem and control groups had similar clinical (100% vs. 94.7%, P = 0.07) and complete (94.8% vs. 92.8%, P = 0.42) success, with comparable minor (4% vs. 6.7%, P = 0.72) and major (0% vs. 4%, P = 0.25) complications; procedural (0% vs. 1.3%, P = 1) and 30-day (1.3% vs. 4%, P = 0.62) mortality were also similar. CONCLUSION The Tandem procedure is as safe and effective as the conventional TLE. It can be applied to leads of a long dwell time with a potentially shorter procedure duration.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Christos Kontogiannis
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Ahmed I Elbatran
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Lisa W M Leung
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Christoph T Starck
- Department of Cardiothoracic Surgery, German Heart Centre, Berlin, Germany
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
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6
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Akhtar Z, Sohal M, Sheppard MN, Gallagher MM. Transvenous Lead Extraction: Work in Progress. Eur Cardiol 2023; 18:e44. [PMID: 37456768 PMCID: PMC10345938 DOI: 10.15420/ecr.2023.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/10/2023] [Indexed: 07/18/2023] Open
Abstract
Cardiac implantable electronic devices are the cornerstone of cardiac rhythm management, with a significant number of implantations annually. A rising prevalence of cardiac implantable electronic devices coupled with widening indications for device removal has fuelled a demand for transvenous lead extraction (TLE). With advancement of tools and techniques, the safety and efficacy profile of TLE has significantly improved since its inception. Despite these advances, TLE continues to carry risk of significant complications, including a superior vena cava injury and mortality. However, innovative approaches to lead extraction, including the use of the jugular and femoral accesses, offers potential for further gains in safety and efficacy. In this review, the indications and risks of TLE are discussed while examining the evolution of this procedure from simple traction to advanced methodologies, which have contributed to a significant improvement in safety and efficacy.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
| | - Mary N Sheppard
- Cardiac Risk in the Young, Cardiovascular Pathology Unit, St George's University of LondonLondon, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital NHS Foundation TrustLondon, UK
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Lead Extraction at a Pediatric/Congenital Heart Disease Center: The Importance of Patient Age at Implant. JACC Clin Electrophysiol 2022; 8:343-353. [PMID: 35331429 DOI: 10.1016/j.jacep.2021.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to evaluate the safety and efficacy of transvenous lead extraction (TLE) at a single pediatric/congenital heart disease (CHD) center. BACKGROUND Data on TLE in pediatric and CHD patients are limited. METHODS Retrospective cohort study evaluating TLE from 2008 to 2019. RESULTS A total of 113 patients underwent TLE with 162 leads removed (including 38 high-voltage leads). Median age at lead implantation was 13 years (range 0.6-61.8 years), with a median age at extraction of 21.6 years (6.4-64.3 years). Median lead age was 7.2 years (1.0-35.3 years). Successful extraction occurred in 110 (97%) patients, 159 (98%) leads. Complex extraction was needed for 120 leads; 52 (44%) using laser alone, 27 (23%) mechanical sheath alone, and 21 (18%) using both. Femoral extraction was used for 19 (16%) leads. Risk factors for complex extraction were ≥2 leads extracted (odds ratio: 3.36; 95% confidence interval [CI]: 1.2-9.36; P = 0.021), lead within the right ventricle (odds ratio: 2.8; 95% CI: 1.2-6.5; P = 0.017), and a combination of younger patient age at implant and older lead age at extraction, with patients ≤12 years of age at implant and leads ≥7 years of age having an odds ratio: of 10.1 (95% CI: 2.21-45.9; P = 0.003). Major complications occurred in 5 (4.4%) of patients, with no mortality, but a high incidence of tricuspid valve injury. CONCLUSIONS TLE can be performed successfully and safely in a pediatric and CHD center. Patient age at lead implantation, not age at extraction, is an important predictor of needing a complex extraction, with younger patients at implant and older leads at extraction having the highest risk.
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Castro-Urda V, Toquero-Ramos J, Sánchez-García M, Jiménez-Sánchez D, Pham-Trung C, Veloza-Urrea D, Solís-Solís LD, Vázquez López-Ibor J, Vilches-Soria S, Cobo-Marcos M, Moñivas-Palomero V, Fernández-Lozano I. Incidencia, tasa de éxito, complicaciones y factores predictores de empleo de la vía femoral en procedimientos percutáneos de extracción de electrodos. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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9
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Isawa T, Honda T, Yamaya K, Taguri M. Predictors of the need for supportive femoral approach during transvenous extraction of pacemaker and defibrillator leads in Japanese patients. J Arrhythm 2020; 36:746-754. [PMID: 32782649 PMCID: PMC7411205 DOI: 10.1002/joa3.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Studies on femoral approach during transvenous lead extraction (TLE) are limited. METHODS We retrospectively evaluated 75 patients undergoing TLE from September 2014 through November 2019 via supportive femoral approach (Femoral/Superior group; n = 22) and superior approach alone (Superior group; n = 53). RESULTS No significant between-group differences were observed regarding patients' baseline characteristics except for a higher incidence of access vein occlusion in the Femoral/Superior group (59.1% vs. 31.4%; P = .037). The Femoral/Superior group exhibited significantly longer dwell times of the oldest extracted lead (median: 13.4 years; interquartile range [IQR]: 8.8-21.2 years vs. median, 7.2 years; IQR: 3.7-10.8 years; P < .001) and a higher incidence of passive fixation ventricular pacemaker lead (81.8% vs. 39.6%; P = .001). Multivariate logistic analysis showed that access vein occlusion (odds ratio [OR]: 4.07, 95% confidence interval [CI]: 1.08-15.3; P < .001) and dwell time of the oldest extracted lead (per year) (OR: 1.22, 95% CI: 1.09-1.37; P = .038) were predictors of the need for supportive femoral approach. Receiver operating characteristic curve analysis revealed that 11.8 years from implant was the cutoff for the need for supportive femoral approach (sensitivity 68.2%, specificity of 81.1%, area under the curve 0.81). CONCLUSIONS Access vein occlusion and long dwell time of the oldest extracted lead predict a high probability of the need for supportive femoral approach. Supportive femoral approach may be necessary in patients with leads that are implanted for >11.8 years and whose access veins are occluded.
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Affiliation(s)
- Tsuyoshi Isawa
- Department of CardiologySendai Kousei HospitalSendaiJapan
| | - Taku Honda
- Department of CardiologySendai Kousei HospitalSendaiJapan
| | - Kazuhiro Yamaya
- Department of Cardiovascular SurgerySendai Kousei HospitalSendaiJapan
| | - Masataka Taguri
- Department of Data ScienceYokohama City University School of Data ScienceYokohamaJapan
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10
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Zhou X, Ze F, Li D, Wang L, Duan J, Yuan C, He J, Guo J, Li X. Transfemoral extraction of pacemaker and implantable cardioverter defibrillator leads using Needle's Eye Snare: a single-center experience of more than 900 leads. Heart Vessels 2019; 35:825-834. [PMID: 31786644 DOI: 10.1007/s00380-019-01539-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/22/2019] [Indexed: 11/27/2022]
Abstract
The femoral approach with the Needle's Eye Snare (NES) is often used for bailout after failure of the superior approach for transvenous lead extraction (TLE). The safety and efficacy of the NES as a first-line tool for TLE remain unclear. The medical records of patients who underwent TLE via the femoral approach utilizing the NES from May 2014 to June 2019 in Peking University People's Hospital were retrospectively reviewed. Nine hundred and eighty-five leads were extracted in 492 patients (369 men; mean age 72.8 ± 29.0 years). The median (range) number of leads extracted per patient was 2 (1-6). The mean indwelling time of all extracted leads was 112.6 ± 52.0 months. The complete procedure success rate, clinical success rate, and failure rate were 94.1% (463/492), 97.8% (481/492), and 1.1% (11/492), respectively. Major complications including death occurred in nine patients (1.9%), of whom eight developed cardiac tamponade. Among these eight patients, emergency pericardiocentesis followed by rescue surgical repair if necessary was successful in 6 (75.0%) and failed in 2 (25.0%). No significant differences were found in the clinical success rate or major complications rate between patients with pacemakers and implantable cardioverter defibrillators, or between patients with infected and uninfected leads. A femoral approach with the NES is safe and effective for TLE of both pacing and defibrillator leads and could be considered a first-line approach. Cardiac tamponade was the most frequent cardiovascular complication. A strategy of emergency pericardiocentesis followed by a rescue surgical approach seems to be reasonable technique to treat a cardiac tamponade.
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Affiliation(s)
- Xu Zhou
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Feng Ze
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Ding Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Long Wang
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Jiangbo Duan
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Cuizhen Yuan
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Jinshan He
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Jihong Guo
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China
| | - Xuebin Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.
- Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China.
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Gould J, Sidhu B, Porter B, Sieniewicz BJ, Teall T, Williams S, Shetty A, Bosco P, Blauth C, Gill J, Rinaldi CA. Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1355-1364. [DOI: 10.1111/pace.13791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/31/2019] [Accepted: 08/18/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Justin Gould
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Baldeep.S. Sidhu
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Bradley Porter
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Benjamin. J. Sieniewicz
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Thomas Teall
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Steven.E. Williams
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Anoop Shetty
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Paolo Bosco
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
| | - Christopher Blauth
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
| | - Jaswinder Gill
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
| | - Christopher. A. Rinaldi
- Cardiology DepartmentGuy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging SciencesKing's College London London UK
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12
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El-Chami MF, Merchant FM. Femoral extraction of transvenous leads and leadless pacemakers-A review of the data, tools, and procedural steps. Pacing Clin Electrophysiol 2019; 42:1248-1252. [PMID: 31355937 DOI: 10.1111/pace.13766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Abstract
Extraction of transvenous leads via the femoral route might be needed when extraction via the implant vein fails or when retained lead fragments exist. The skill set required for this procedure is unique as it relies on the ability to snare and the use of a variety of shelf tools. In this era of leadless pacing, this skill set might be called upon more frequently. In this article, we review the data, tools, and procedural steps of femoral lead extraction and retrieval/extraction of leadless pacemakers.
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Affiliation(s)
- Mikhael F El-Chami
- Department of Medicine-Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Faisal M Merchant
- Department of Medicine-Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
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13
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Gabriels J, Chang D, Donnelly J, Kim BS, Willner J, Beldner S, Epstein LM. When bigger is better: Novel use of a 27 F leadless pacemaker delivery sheath for femoral lead extractions. Heart Rhythm 2019; 17:152-157. [PMID: 31284049 DOI: 10.1016/j.hrthm.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 11/25/2022]
Affiliation(s)
- James Gabriels
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
| | - David Chang
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Joseph Donnelly
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Beom Soo Kim
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Jonathan Willner
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Stuart Beldner
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Laurence M Epstein
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
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14
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Kiani S, Sabayon D, Lloyd MS, Hoskins MH, El‐Chami MF, Westerman S, Vadlamudi R, Keeling B, Lattouf OM, Merchant FM. Outcomes of percutaneous vacuum‐assisted debulking of large vegetations as an adjunct to lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1032-1037. [DOI: 10.1111/pace.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Soroosh Kiani
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Dean Sabayon
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Michael S. Lloyd
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Michael H. Hoskins
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Mikhael F. El‐Chami
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Stacy Westerman
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Ratna Vadlamudi
- Department of AnesthesiologyEmory University School of Medicine Atlanta Georgia
| | - Brent Keeling
- Division of Cardiothoracic Surgery, Department of SurgeryEmory University School of Medicine Atlanta Georgia
| | - Omar M. Lattouf
- Division of Cardiothoracic Surgery, Department of SurgeryEmory University School of Medicine Atlanta Georgia
| | - Faisal M. Merchant
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
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15
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Abstract
INTRODUCTION Congenital complete heart block affects 1/15,000 live-born infants, predominantly due to atrioventricular nodal injury from maternal antibodies of mothers with systemic lupus erythermatosus or Sjogren's syndrome. The majority of these children will need a pacemaker implanted prior to becoming young adults. This article will review the various patient and technical factors that influence the type of pacemaker implanted, and the current literature on optimal pacing practices. Areas covered: A literature search was performed using PubMed, Embase and Web of Science. Data regarding epicardial versus transvenous implants, pacing-induced ventricular dysfunction, alternative pacing strategies (including biventricular pacing, left ventricular pacing, and His bundle pacing), and complications with pacemakers in the pediatric population were reviewed. Expert commentary: There are numerous pacing strategies available to children with congenital complete heart block. The risks and benefits of the initial implant should be weighed against the long-term issues inherent with a life-time of pacing.
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Affiliation(s)
- Stephanie F Chandler
- a Department of Cardiology , Boston Children's Hospital , Boston , MA , USA.,b Department of Pediatrics , Harvard Medical School , Boston , MA , USA
| | - Francis Fynn-Thompson
- c Department of Cardiovascular Surgery , Boston Children's Hospital , Boston , MA , USA.,d Department of Surgery , Harvard Medical School , Boston , MA , USA
| | - Douglas Y Mah
- a Department of Cardiology , Boston Children's Hospital , Boston , MA , USA.,b Department of Pediatrics , Harvard Medical School , Boston , MA , USA
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